Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health.
|
|
- Brianne Bryan
- 6 years ago
- Views:
Transcription
1 Prof.Duru Shah Founder President The PCOS Society (India) President Elect of the Indian Society for Assisted Reproduction (ISAR) Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health. Director Gynaecworld.. The Center for Womens Health & Fertility Prof.and : Breach Candy Hosp. Cons. Obs. Jaslok Hospital & Gyn Global Hospital
2 Assisted Reproduction for PCOS-are the results different? Prof. MD FRCOG FCPS FICS FICOG FICMCH DGO DFP PCOS Understanding the Science and Practice 19 th June, 2016 Mumbai
3 Background PCOS patients comprise 75% of ovulatory infertility. Studies have suggested that PCOS women may have less favorable outcomes with ARTconflicting evidence PCOS patients have oocytes, but of impaired quality fertilization, cleavage, implantation rates and miscarriage rates. Re. Standmauer L. et.al.(2005) Treat Endocrinol 4: Heijnen EM et. al. (2006) Hum Reprod. Update 12: Sahu K., et. al.(2008) Arch Gynecol Obstet 277:
4 Areas to be discussed Does PCOM affect the quality of eggs and embryos? Does obesity due to PCOS affect results in ART? Is the outcome of ART in PCOS women different from non-pcos women?. Is the Fertile window extended in women with PCOS? Is In Vitro Maturation (IVM) a better solution?
5 Does PCOM affect the quality of eggs and embryos? Prospective comparative study of 194 PCOS pts. with age matched controls treated concurrently. COH + ICSI All 194 women had exclusive male infertility 97 had PCOM and 97 were normal (control group) 1013 oocytes from PCOM patients compared with 774 oocytes from controls. Ref. Sigale et.al. Fertil Steril Jan 2015
6 Results Mean number of total + M II oocytes sig. in PCOM group. Rate of M II morphologically abnormal oocytes equivalent between both groups. Mean no. of embryos significantly in PCOM group. Percentage of top quality embryos on Day 3 similar between both the groups. Ref. Sigale et.al. Fertil Steril Jan 2015
7 Results Implantation and clinical pregnancy rates were significantly in PCOM group. Conclusions PCOM does not have a negative impact on the quality of oocytes and embryos or the outcome of IVF / ICSI. Ref. Sigale et.al. Fertil Steril Jan 2015
8 Does Obesity affect ART results in PCOS? Retrospective Cohort Study 101 cycles in 79 PCOS women < 40 yrs. Lean (51) kg/m 2 Overweight (19) kg/m 2 Obese (31) - > 30 kg/ m 2 Aim was to study the effect of BMI on ART outcomes in a PCOS population. Ref. Amelia P. Bailey et.al. Am J. Obstet Gynecol 2014: 211: 163
9 Conclusions:- PCOS has 2 distinct populations lean and obese Both have different IVF outcomes Obese PCOS have a 75% chance of pregnancy rate per ET, compared with lean PCOS The odds of live birth were 77% lower per ET in obese v/s lean PCOS There is a chance of OHSS in BMI in women with PCOS % in lean PCOS % overweight % obese Ref. Amelia P. Bailey et.al. Am J.Obstet Gynecol 2014:211:163
10 Outcome of ART in PCOS v/s Non PCOS women Prospective Study Group I women with PCOS with 122 Group II - 91 women with tubal factor infertility Re. Salem WH et.al. Androl Gynecol: Curr Res 2014,2:3
11 Outcome of ART in women with PCOS v/s Tubal Factor Ovarian stimulation characteristics PCOS (n=122) Re. Salem WH et.al. Androl Gynecol: Curr Res 2014,2:3 Tubal Factor (n=91) P-Value Agonist 0% 70.3% <0.001 Antagonist 100% 29.7% <0.001 Total duration of treatment (days) 9.5 ± ± 2.1 NS Total dose of rfsh or Gonadotropin (IU) 1910 ± ± 1040 <0.001 Serum E 2 on day of HCG(ng/mL) 2370 ± ± 1247 NS Serum P 4 on day of HCG(ng/mL 1.1 ± ± 0.4 <0.01 # Follicles 14 on day of HCG 15.6 ± ± 5.6 <0.001 # Follicles 16 on day of HCG 9.4 ± ± 3.8 <0.01 Endometrial thickness (mm) on day of HCG 10.6 ± ± 2.0 <0.01
12 Outcome of ART in women with PCOS v/s Tubal Factor Embryology Data PCOS (n=122) Tubal Factor (n=91) P-Value # Mature oocytes <0.001 # 2 PN <0.001 Fertilization rate 76.0% 79.6% <0.05 #Frozen zygote <0.01 # Day 3 embryos <0.001 # Day 5 blastocysts <0.001 # Day 6 blastocysts NS # Day 5 Frozen blastocyst NS # Day 6 frozen blastocysts NS # Total frozen blastocysts NS Re. Salem WH et.al. Androl Gynecol: Curr Res 2014,2:3
13 Outcome of ART in women with PCOS v/s Tubal Factor Embryology Data PCOS (n=122) Tubal Factor (n=91) P-Value # Embryos transferred (Day 3) NS Morula transferred (Day 5) NS Blastocysts transferred (Day 5) <0.001 Excellent blastocysts <0.05 Good blastocysts NS Early blastocysts NS # total transferred Day 5 (morula and blastocyst) NS % of Day 3 transfer 22.1% 41.8% <0.01 Re. Salem WH et.al. Androl Gynecol: Curr Res 2014,2:3
14 Outcome of ART in women with PCOS v/s Tubal Factor Pregnancy outcome PCOS (n=122) Tubal Factor (n=91) P-Value Implantation rate 40.9% 34.6% NS Clinical pregnancy(%) 76(62.3%) 49(53.8%) NS Delivered (%) 69(56.6%) 45(49.5%) NS Biochemical pregnancy (%) 9(10.6%) 2(3.9%) NS Miscarriage(%) 7(9.2%) 4(8.1%) NS Multiple pregnancy (%) 34(44.7%) 23(46.9%) NS Re. Salem WH et.al. Androl Gynecol: Curr Res 2014,2:3
15 Embryology Data Gynaecworld Data PCOS (n=189) Non-PCOS (n=133) P-Value Total number of follicles < Mean number of follicles Total number of oocytes <0.001 Mean number of oocytes NS Total number of mature oocytes < Mean number of mature oocytes Recovery rate of mature oocytes(%) 70.04% 84.14% Total number of immature oocytes <0.001 Mean number of immature oocytes Fertilization rates 74.00% (1500/2027) Cleavage rates 70.93% (1064/1500) Re. Gynaecworld unpublished data % (923/1157) 76.02% (704/926) < (NS)
16 Pregnancy outcome Gynaecworld Data PCOS Non-PCOS P-Value OHSS 12.69% 8.27% (11/133) < 0.02 Significant Pregnancy rate 38.09% (72/189) Live birth rate 73.61% (53/72) Abortion rate 5.55% (4/72) Biochemical preg. Rate 8.33% (6/72) Ectopic preg.rate 2.77% (2/72) Re. Gynaecworld unpublished data % (54/133) 72.22% (39/54) 7.40% (4/54) 5.55% (3/54) 3.70% (2/54) < 0.65 NS < 0.86 NS < 0.67 NS < NS < 0.72 NS
17 ART in PCOS- Multicentric Indian Trial Study: Prospective Observational study on PCOS carried out in 7 centers in India between Aug July women undergoing IVF / ICSI included 77 - PCOS 115 Non PCOS All patients had Long protocols and Rec. FSH Ref. Pratap Kumar et.al. J Hum Reprod Sci Jan- Mar.6(1) 49-53
18 ART in PCOS- Multicentric Indian Trial Results: PCOS Group Non PCOS Group Follicles 27.2 ± ± 5.3 Oocytes 15.9 ± ± 6.2 Recovery rate of oocytes 64% 80.3% Mature oocytes 61.1% 74.5% Total no. of top quality embryos Pregnancy Rates comp. to Non PCOS groups Comparable in both groups. Ref. Pratap Kumar et.al. J Hum Reprod Sci Jan- Mar.6(1) 49-53
19 Is the Fertile window extended in women with PCOS? Known Facts PCOS women have density of small Antral follicles. Ovarian cortical biopsies show a 6 times density of primordial and primary follicles in women with PCOS v/s women with regular periods. Surrogate markers of ovarian reserve such as AMH and AFC are also increased in PCOS. Ref. Webber LJ. et.al. Lancet 2003; 362:
20 This could suggest that either PCOS women are born with an increased no. of germ cells at birth or there is a rate of loss of germ cells. Does this mean that women with PCOS have a higher chance to be pregnant v/s non PCOS women as they age? How should we counsel our patients? Ref. Webber LJ. et.al. Lancet 2003; 362:
21 Is the Fertile window extended in women with PCOS? Most of the patients get pregnant with oral ovulation inducing agents, but some require ART due to co-existing causes of infertility or to prevent multiple pregnancy due to COH Ref. Hudeova M et.al. Hum. Reprod. 2009: 24: Koivunen R. et.al. Hum. Reprod. 2008: 23:2134-9
22 Is the fertile window extended in women with PCOS? Retrospective Cohort study 42, 286 IVF cycles in women with PCOS and tubal factor infertility. Utilizing the SART Registry Out come Pregnancy and live birth rates. Ref. Kalra SK, Dokra A,. et.al. Fertility & Sterility vol. 100, July 2013:
23 Is the fertile window extended in women with PCOS? PCOS Tubal Factor P-Value Total IVF cycles 16, NS No. of oocytes retrieved No. of cryopreserved embryos, mean ± SD 6 ± ± 4.3 <.001 Subjects with cryopreserved embryos,% <.001 Implantation rate,% <.001 Clinical preg. rate/ cycle start,% <.001 Miscarriage rate, % <.001 Live-birth rate/ cycle start,% <.001 Pregnancy plurality, % Singleton Twin Higher order multiple preg.( triplet) Re. Kalra SK, Dokra A, et.al Fertility & Sterility vol :
24 Is the fertile window extended in women with PCOS? Conclusions In spite of an increased number of oocytes obtained in PCOS patients in all age groups, women above 40 years had the same clinical preg. rates and live birth rates as non PCOS women and there was no reproductive advantage. Ref. Kalra SK, Dokra A,. et.al. Fertility & Sterility vol. 100, July 2013:
25 Is the fertile window extended in women with PCOS? Conclusions These findings suggest that the reproductive window may not be extended in PCOS. Hence women with PCOS should also be treated in a timely manner in spite of high ovarian reserve indicators. Ref. Kalra SK, Dokra A,. et.al. Fertility & Sterility vol. 100, July 2013:
26 Invitro Maturation (IVM) In PCOS patients, COH may lead to:- Large cohort of foll. of uneven sizes and quality. Retrieval of Immature oocytes risk of OHSS To avoid above, earlier retrieval of immature oocytes followed by IVM + IVF / ICSI is suggested. But does IVM give comparable outcomes? Ref. Cochrane Database Syst. Rev. Oct. 2013
27 Aim: To compare the outcomes assosc. with IVM foll. by IVF/ ICSI v/s Conventional IVF / ICSI All RCT s reviewed for assessing eligibility and quality of trials. No RCT s were suitable for inclusion in the Review, 3 ongoing trials currently but. Conclusions:- Invitro Maturation (IVM) Promising data on IVM techniques have been published, yet no evidence from RCTS available in order to base any practice recommendations. Ref. Cochrane Database Syst. Rev. Oct. 2013
28 Are the children born after IVM Study normal? Obst. and Perinatal Data collected from all deliveries after IVM treatment Growth and development of IVM children were assessed at 6,12,24 months. 43 women del. 40 singleton infants 3 sets of Twins Ref. Soderstrom et. Al. Hum Reprod. June 2006
29 Obstetric & Perinatal Outcome after IVM Obst. Complications- 15 pregnancies (35%) Mean B.Wt. of singletons = 3550 ± 441 gms. Twins = 2622 ± 194 gms. Preterm Birth No perinatal deaths: at 12 months- 8 children (19%) minor devel. problems. 1 child optical glioma at 24 months- Neuro psychological development normal range Ref. Soderstrom et. Al. Hum Reprod. June 2006
30 Conclusions PCOM does not have a negative impact on the quality of oocytes and embryos or the outcome of IVF / ICSI Obesity with PCOS chance of pregnancy, live birth, OHSS. Pregnancy outcome is comparable in PCOS and non PCOS women. PCOS women above 40 do not have reprod. advantage over non PCOS women No evidence from RCTs to confirm if In vitro Maturation gives birth result.
President : Indian Society for Assisted Reproduction (ISAR) Past President FOGSI. Past Chairman ICOG. Founder Trustee Women s Empowerment Foundation
Founder President: The PCOS Society, India Honorary Fellow of the Royal College of Obst.& Gyn. Prof.Duru Shah President : Indian Society for Assisted Reproduction (ISAR) Past President FOGSI. Past Chairman
More informationInfluence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser
Influence ovarian stimulation on oocyte and embryo quality Prof.Dr. Bart CJM Fauser How to balance too much vs too little? Lecture Outline Context ovarian stimulation Impact ovarian stimulation on oocyte
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,
More informationNumber of oocytes and live births in IVF
Number of oocytes and live births in IVF Dr Sesh K Sunkara MD, MRCOG Royal Marsden Hospital, London Kings Healthcare Partners (Guy s & St Thomas NHS Foundation Trust), London, UK Background IVF results
More informationIVM in PCOS patients. Introduction (1) Introduction (2) Michael Grynberg René Frydman
IVM in PCOS patients Michael Grynberg René Frydman Department of Obstetrics and Gynecology A. Beclere Hospital, Clamart, France Maribor, Slovenia, 27-28 February 2009 Introduction (1) IVM could be a major
More informationThrombosis during assisted reproduction. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology
Thrombosis during assisted reproduction Scott Nelson Muirhead Chair in Obstetrics & Gynaecology ART can be as safe as natural pregnancy!! What used to be the risk of thrombosis in ART!! We can use AMH
More informationMinimising IVF related mortality and morbidity. Scott Nelson Muirhead Professor in Obstetrics & Gynaecology
Minimising IVF related mortality and morbidity Scott Nelson Muirhead Professor in Obstetrics & Gynaecology We rarely say no - so what I will cover today VTE as an example of a modifiable IVF complication
More informationUniversal Embryo Cryopreservation: Frozen versus Fresh Transfer. Zaher Merhi, M.D.
Universal Embryo Cryopreservation: Frozen versus Fresh Transfer Zaher Merhi, M.D. Disclosure: None Fewer complications with IVF 1.5% children in US are born through ART 1.1 million children since 2006
More informationAre all-freeze cycles & frozen-thawed embryo transfers improving IVF outcomes?
Are all-freeze cycles & frozen-thawed embryo transfers improving IVF outcomes? Andrea Weghofer Foundation for Reproductive Medicine 2017 New York, November 16-19 Conflict of interest No relevant financial
More informationSTIMULATION AND OVULATION TRIGGERING
STIMULATION AND OVULATION TRIGGERING Professor IOANNIS E. MESSINIS MD, PhD (Aberdeen, UK), FRCOG (UK) Department of Obs/Gynae University of Thessaly Larissa, GREECE DISCLOSURE Nothing to disclose Learning
More informationIVF AND PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) WHAT THE COMMUNITY PHYSICIAN NEEDS TO KNOW
IVF AND PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) WHAT THE COMMUNITY PHYSICIAN NEEDS TO KNOW Jon Havelock, MD, FRCSC, FACOG Co-Director - PCRM Disclosure No conflict of interest in relation
More informationDoes PCOS Compromise the oocyte and embryo quality or the endometrium?
Does PCOS Compromise the oocyte and embryo quality or the endometrium? Richard S. Legro, M.D., Penn State College of Medicine, Dept of Ob/Gyn, Hershey, PA, USA Disclosures Consultant: Bayer, Ogeda (Euroscreen),
More information% Oocyte Donation Pregnancyes (days 3)
Ovulation induction in oocyte donors Roma- September 2007 Dr. José Remohí Dr. Carmen Rubio Dr. Amparo Mercader Dr. Pilar Alama Dr. Marco Melo Evolution of oocyte donation cycles 1500 1500 1000 58% 661
More informationPoor & Hyper responders: what is the best approach?
Poor & Hyper responders: what is the best approach? A. La Marca ObGyn Dept University of Modena and Reggio Emilia Italy Center for Reproductive Medicine University Hospital of Modena Italy Criteria used
More informationChen et al. Reproductive Biology and Endocrinology (2018) 16:36 https://doi.org/ /s z
Chen et al. Reproductive Biology and Endocrinology (2018) 16:36 https://doi.org/10.1186/s12958-018-0352-z RESEARCH Open Access Pregnancy outcomes of PCOS overweight/ obese patients after controlled ovarian
More informationProgesterone and clinical outcomes
Synchronization of Slowly Developing Embryos Restores Implantation Success Richard T. Scott, Jr, MD, HCLD Clinical and Scientific Director, Reproductive Medicine Associates of New Jersey Professor and
More informationSample size a Main finding b Main limitations
1 Table 1. Available studies on the relation between endometriosis and miscarriage (1995-2015). Study (citation) Country Study period Study design Sample size a Main finding b Main limitations Matoras
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationTrends in Egg Donation. Vitaly A. Kushnir MD Center for Human Reproduction
Trends in Egg Donation Vitaly A. Kushnir MD Center for Human Reproduction Disclosures No relevant financial relationships to disclose CHR views the commercial trade in human oocytes with considerable ethical
More informationBest practices of ASRM and ESHRE
Best practices of ASRM and ESHRE Late submission Cortina d Ampezzo, Italy 1-3 March 2012 A joint meeting between the American Society for Reproductive Medicine and the European Society of Human Reproduction
More informationMilder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization
Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization Revelli et al. Reproductive Biology and Endocrinology 2011, 9:25 Presenter: R2 孫怡虹 Background
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More information(BMI)=18.0~24.9 kg/m 2 ;
33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV
More informationFertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr.
Dr. Shahin Ghadir A Primary Care Approach to Diagnosing and Treating Infertility St. Charles Bend Grand Rounds November 30, 2018 I have no conflicts of interest to disclose. + About SCRC State-of-the-art
More informationDr Guy Gudex. Director Repromed. 17:00-17:30 Recent Advances in Fertility Management
Dr Guy Gudex Director Repromed 17:00-17:30 Recent Advances in Fertility Management Recent Advances in Fertility Management Practice Nurses Programme NZMA GP CME June 2018 Dr Guy Gudex ART in NZ -2014 ACART
More informationIs it the seed or the soil? Arthur Leader, MD, FRCSC
The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events
More informationEmbryo Selection after IVF
Embryo Selection after IVF Embryo Selection after IVF Many of human embryos produced after in vitro fertilization carry abnormal chromosomes. Placing a chromosomally normal embryo (s) into a normal uterus
More informationLuteal phase rescue after GnRHa triggering Progesterone and Estradiol
Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective
More informationThe old IVF patient: An evidence based approach. Stratis Kolibianakis MD MSc PhD
The old IVF patient: An evidence based approach Stratis Kolibianakis MD MSc PhD Unit for Human Reproduction 1 st Dept Ob/Gyn Aristotle University of Thessaloniki No conflict of interest How old is old?
More informationA multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of
A multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of Endometrioma and deep infiltrating endometriosis Professor C. Chapron and the Group
More informationIS PCOS ASSOCIATED WITH A HIGHER PREGNANCY LOSS? NO BY DR SHEELA V.MANE
IS PCOS ASSOCIATED WITH A HIGHER PREGNANCY LOSS? NO BY DR SHEELA V.MANE CURRICULUM VITAE Name Qualifications : Prof. Sheela V. Mane : MBBS, M.D, FICOG, FICMCH Contribution to FOGSI: Chairperson Safe Motherhood
More informationIndividualized treatment based on ovarian reserve markers
Individualized treatment based on ovarian reserve markers Prof Dr. Nikolaos P. Polyzos M.D. PhD Professor and Medical Co- Director, Vrije Universiteit Brussel, UZ Brussel, Belgium Professor of Reproduc?ve
More informationlbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour
lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate
More informationDr Guy Gudex. Gynaecologist and Fertility Specialist Repromed. 9:05-9:30 Advances in Assisted Reproduction What s New?
Dr Guy Gudex Gynaecologist and Fertility Specialist Repromed 9:05-9:30 Advances in Assisted Reproduction What s New? Rotorua GP CME June 2016 Advances in Assisted Reproduction-What s new? Dr Guy Gudex
More informationOvarian hyperstimulation syndrome (OHSS)
Ovarian hyperstimulation syndrome (OHSS) OHSS OHSS: exaggerated response to gonadotropins and hcg Characterized by: ovarian enlargement increased vascular permeability fluid accumulation in abdomen Associated
More informationIVF Health Risk 503,000 Hit in Google in 0.2 seconds
Assisted Reproductive Technologies and Perinatal Morbidity: Interrogating the Association Kurt Barnhart, M.D., MSCE. William Shippen Jr Professor of Obstetrics and Gynecology and Epidemiology Perelman
More informationIVF Protocols: Hyper & Hypo-Responders, Implantation
IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient
More informationA new approach to IVF? Soft or mild IVF. Soft or mild IVF
A new approach to IVF? William Ledger University of Sheffield Centre for Reproductive Medicine and Fertility (w.ledger@sheffield.ac.uk) Soft or mild IVF Less patient discomfort Less complex, shorter stimulation
More informationSingle Embryo Transfer
Single Embryo Transfer Rachel Cutting Principal Embryologist Chair Association of Clinical Embryologists Summary Background to change in UK policy National data Strategies Embryo selection Practical requirements
More informationIn Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome
Original Article Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Maryam Eftekhar, M.D. 1, Razieh Deghani Firoozabadi,
More informationUnderstanding IVF Processes in Surrogacy
Melvin H. Thornton II MD Medical Director CT Fertility Understanding IVF Processes in Surrogacy The Basics Surrogacy involves multiple parties IVF CLINIC Egg donors screening and matching* Medical process
More informationPrognosticating ovarian reserve by the new ovarian response prediction index
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tak A et al. Int J Reprod Contracept Obstet Gynecol. 2018 Mar;7(3):1196-1200 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180917
More informationOptimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE
Optimizing Fertility and Wellness After Cancer Kat Lin, MD, MSCE University Reproductive Care University of Washington Nov. 6, 2010 Optimism in Numbers 5-year survival rate 78% for all childhood cancers
More informationIntérêt de l hcg et induction de l ovulation. Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium
Intérêt de l hcg et induction de l ovulation Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium Conflict of interest The opinions expressed in this document are the opinions
More informationPersonalizing ovarian stimulation for IVF
Personalizing ovarian stimulation for IVF Biljana Popovic-Todorovic MD,PhD Centre for Reproductive Medicine UZ Brussel QuickTime and are needed to see this picture. Controlled ovarian stimulation for IVF/ICSI
More informationImpact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles
1 st SEUD Meeting, 9 May 2015, Paris, France Impact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles ENDOMETRIOSIS ovarian endometrioma
More informationModified natural cycles: the Italian experience
CLINICA VALLE GIULIA, Rome Modified natural cycles: the Italian experience Filippo Maria Ubaldi M.D. M.Sc. Poor ovarian Response ESHRE Campus symposium Bologna 19-20 March 2010 Introduction Ovarian superovulation
More informationLUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi
LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency
More informationIVF (,, ) : (HP-hMG) - (IVF- ET) : GnRH, HP-hMG (HP-hMG )57, (rfsh )140, (Gn)
34 11 Vol.34 No.11 2014 11 Nov. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-3X.2014.11.0892 E-mail: randc_journal@163.com IVF ( 710003) : (H-hMG) - (IVF- ET) : GnRH H-hMG (H-hMG ) (rfsh
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationDr Manuela Toledo - Procedures in ART -
Dr Manuela Toledo - Procedures in ART - Fertility Specialist MBBS FRANZCOG MMed CREI Specialities: IVF & infertility Fertility preservation Consulting Locations East Melbourne Planning a pregnancy - Folic
More informationUse of in vitro maturation for fertility preservation
Use of in vitro maturation for fertility preservation G. Arroyo Servei de Medicina de la Reproducció Departament d Obstetrícia, Ginecologia i Reproducció INSTITUT UNIVERSITARI DEXEUS MEDICAL STRATEGY TO
More informationManish Banker. Declared receipt of grants; member of a company advisory board, board of director or similar group
Manish Banker Nova IVI Fertility Pulse Women's Hospital Gujarat, India Declared receipt of grants; member of a company advisory board, board of director or similar group The Indian point of view Manish
More informationHow to make the best use of the natural cycle for frozen-thawed embryo transfer?
How to make the best use of the natural cycle for frozen-thawed embryo transfer? Ariel Weissman, MD IVF Unit, Dep. Ob/Gyn Wolfson Medical Center, Holon Sackler Faculty of Medicine, Tel Aviv University
More informationMinimal monitoring / Minimal stimulation as a means of increasing access to ART in developing countries
Minimal monitoring / Minimal stimulation as a means of increasing access to ART in developing countries Willem Ombelet Genk Institute for Fertility Technology Maribor, 27-02-09 Third World = overpopulation
More informationJMSCR Vol 06 Issue 09 Page September 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i9.53 Role of Anti-Mullerian Hormone
More informationLaboratoires Genevirer Menotrophin IU 1.8.2
Important missing information VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Infertility is when a woman cannot get pregnant (conceive) despite having regular unprotected sexual
More informationPRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018
PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 Clinical Assessment A thorough clinical evaluation is a prerequisite for ART A thorough clinical evaluation as detailed in the female and male
More informationINDICATIONS OF IVF/ICSI
PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian
More informationNatural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR)
Natural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR) Geeta Nargund Head of Reproductive Medicine St George s Hospital London ISMAAR Terminology Human Reprod Nargund et al
More informationChromosomal Aneuploidy
The Many Advantages of Trophectoderm Biopsy Compared to Day 3 Biopsy for Pre- Implantation Genetic Screening (PGS) Mandy Katz-Jaffe, PhD Chromosomal Aneuploidy Trisomy 21 Fetus Aneuploidy is the most common
More informationHow effective is egg freezing as a preventative treatment for young women in securing their ability to reproduce later in life?
How effective is egg freezing as a preventative treatment for young women in securing their ability to reproduce later in life? Vitaly A. Kushnir MD Center for Human Reproduction New York City Milestones
More informationThe effect of luteal phase progesterone supplementation on natural frozen-thawed embryo transfer cycles
Original Article Obstet Gynecol Sci 2014;57(4):291-296 http://dx.doi.org/10.5468/ogs.2014.57.4.291 pissn 2287-8572 eissn 2287-8580 The effect of luteal phase progesterone supplementation on natural frozen-thawed
More informationNGUYEN QUOC ANH. M.D., M.Sc. Tu Du Hospital Vietnam
NGUYEN QUOC ANH M.D., M.Sc. Tu Du Hospital Vietnam FULLY AUTOMATED AMH TESTING OF OVARIAN RESPONSE IN IVF NGUYỄN QUỐC ANH MD. Infertility dep. Tudu hospital Index What is AMH? Standard AMH testing Fully
More informationPatient selection criteria for blastocyst culture in IVF/ICSI treatment
J Assist Reprod Genet (2010) 27:555 560 DOI 10.1007/s10815-010-9457-9 ASSISTED REPRODUCTION Patient selection criteria for blastocyst culture in IVF/ICSI treatment M. Y. Thum & V. Wells & H. Abdalla Received:
More informationEffect of ovarian stimulation on oocyte quality and embryonic aneuploidy: a prospective, randomised controlled trial
FULL PROJECT TITLE: Effect of ovarian stimulation on oocyte quality and embryonic aneuploidy: a prospective, randomised controlled trial (STimulation Resulting in Embryonic Aneuploidy using Menopur (STREAM)
More informationFERTILITY PRESERVATION. Juergen Eisermann, M.D., F.A.C.O.G South Florida Institute for Reproductive Medicine South Miami Florida
FERTILITY PRESERVATION Juergen Eisermann, M.D., F.A.C.O.G South Florida Institute for Reproductive Medicine South Miami Florida 1 2 3 4 Oocyte Cryopreservation Experimental option Offer to single cancer
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationInfertility Clinical Guideline
Infertility Clinical Guideline Ovarian Stimulation Guideline Purpose: To provide sufficient background regarding various ovarian stimulation protocols for In Vitro Fertilization cycles. Goal: To assist
More informationAnti-Mullerian hormone (AMH) as predictor of ovarian reserve
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Shembekar CA et al. Int J Reprod Contracept Obstet Gynecol. 2017 Sep;6(9):4006-4010 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174053
More informationBiomarkers for Prediction of Pregnancy Outcome in Fertility Patients. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology
Biomarkers for Prediction of Pregnancy Outcome in Fertility Patients Scott Nelson Muirhead Chair in Obstetrics & Gynaecology Why do we need to know ovarian response? Anna Sarah Just do IVF and see response
More informationDr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain. Declared no potential conflict of interest
Dr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain Declared no potential conflict of interest Is there a role for LH in elderly patients? Dr. Ernesto Bosch Instituto Valenciano de Infertilidad.
More informationAgonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M
Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic
More informationEvaluation of ovarian response prediction according to age and serum AMH levels in IVF cycles: a retrospective analysis
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Pillai SM et al. Int J Reprod Contracept Obstet Gynecol. 2017 Aug;6(8):3306-3310 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173190
More informationBody mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome
Yang et al. Reproductive Biology and Endocrinology (2018) 16:119 https://doi.org/10.1186/s12958-018-0438-7 RESEARCH Open Access Body mass index and basal androstenedione are independent risk factors for
More informationFertility Policy. December Introduction
Fertility Policy December 2015 Introduction Camden Clinical Commissioning Group (CCG) is responsible for commissioning a range of health services including hospital, mental health and community services
More informationEuropean IVF Monitoring (EIM) Year: 2013
European IVF Monitoring (EIM) Year: 2013 Name of the country Poland Name and full address of the contact person. Anna Janicka, PhD Polish Society of Reproductive Medicine and Embryology Fertility and Sterility
More informationUnderstanding eggs, sperm and embryos. Marta Jansa Perez Wolfson Fertility Centre
Understanding eggs, sperm and embryos Marta Jansa Perez Wolfson Fertility Centre What does embryology involve? Aims of the embryology laboratory Creation of a large number of embryos and supporting their
More informationMyths About Success Rates Do they truly reflect quality of care
Myths About Success Rates Do they truly reflect quality of care Barry Behr PhD., HCLD Professor and IVF Laboratory Director Division of Reproductive Endocrinology and Infertility Dept OB/GYN Stanford University
More informationCOMPARING AMH, AFC AND FSH FOR PREDICTING HIGH OVARIAN RESPONSE IN WOMEN UNDERGOING ANTAGONIST PROTOCOL
COMPARING AMH, AFC AND FSH FOR PREDICTING HIGH OVARIAN RESPONSE IN WOMEN UNDERGOING ANTAGONIST PROTOCOL Nguyen Xuan Hoi1, Nguyen Manh Ha2 1 National Obstetrics and Gynecology Hospital, 2Hanoi Medical Unviversity
More informationPrognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK
Prognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK Obstetrics Gynecology and Reproductive Medicine Department Bichat
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationHow to make the best use of the natural cycle for frozen-thawed embryo transfer?
How to make the best use of the natural cycle for frozen-thawed embryo transfer? Ariel Weissman, MD IVF Unit, Dep. Ob/Gyn Wolfson Medical Center, Holon Sackler Faculty of Medicine, Tel Aviv University
More informationFertility Preservation for Breast Cancer. Elizabeth S. Ginsburg MD Medical Director, ART Program Brigham & Women s Hospital
Fertility Preservation for Breast Cancer Elizabeth S. Ginsburg MD Medical Director, ART Program Brigham & Women s Hospital Learning Objectives To be able to list and describe processes of ovulation induction
More informationThe Jones Institute for Reproductive Medicine Founded on Science, Dedicated to Life
The Jones Institute for Reproductive Medicine Founded on Science, Dedicated to Life Assisted reproductive technologies: State-of-the-ART Sergio Oehninger, MD, PhD Professor and Vice-Chair, Dept. Ob/Gyn
More informationEndometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY
Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:
More informationThe emergence of Personalized Medicine protocols for IVF.
Individualising IVF: Introduction to the POSEIDON Concept Introduction The emergence of Personalized Medicine protocols for IVF. Differences between patients: age, ovarian reserve, BMI or presence of ovarian
More informationDipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche. Tecniche di sincronizzazione ovocitaria. La sincronizzazione follicolare
Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche Tecniche di sincronizzazione ovocitaria. La sincronizzazione follicolare Carlo Alviggi The rational of Follicular synchronization
More informationA mild strategy in IVF results in favourable outcomes in terms of term live birth, cost and patient discomfort
Chapter 6 A mild strategy in IVF results in favourable outcomes in terms of term live birth, cost and patient discomfort Heijnen E.M., Eijkemans M.J., De Klerk C., Polinder S., Beckers N.G., Klinkert E.R.,
More informationPolycystic Ovary Disease: A Common Endocrine Disorder in Women
Polycystic Ovary Disease: A Common Endocrine Disorder in Women Paul Kaplan, M.D. Clinical Professor of Reproductive Endocrinology - OHSU Courtesy Senior Research Associate, Human Physiology University
More informationHana Park, Chung-Hoon Kim, Eun-Young Kim, Jei-Won Moon, Sung-Hoon Kim, Hee-Dong Chae, Byung-Moon Kang
Original Article Obstet Gynecol Sci 2015;58(6):481-486 http://dx.doi.org/10.5468/ogs.2015.58.6.481 pissn 2287-8572 eissn 2287-8580 Effect of second-line surgery on in vitro fertilization outcome in infertile
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationHow to advise the couple planning to conceive: Modifiable factors that may (or may not) impact fertility
How to advise the couple planning to conceive: Modifiable factors that may (or may not) impact fertility I have nothing to disclose Disclosures Heather Huddleston, MD Associate Professor of Clinical Medicine
More informationA prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF
FVV IN OBGYN, 2012, 4 (2): 82-87 Original paper A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF S. GORDTS,
More informationMenstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
More informationSaudi Journal of Medicine (SJM)
Saudi Journal of Medicine (SJM) Scholars Middle East Publishers Dubai, United Arab Emirates Website: http://scholarsmepub.com/ ISSN 2518-3389 (Print) ISSN 2518-3397 (Online) Factors Affecting Outcomes
More informationThe serum estradiol/oocyte ratio in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins
Original Article Obstet Gynecol Sci 2018;61(2):242-246 https://doi.org/10.5468/ogs.2018.61.2.242 pissn 2287-8572 eissn 2287-8580 The serum estradiol/oocyte ratio in patients with breast cancer undergoing
More informationApproved January Waltham Forest CCG Fertility policy
Approved January 2015 Waltham Forest CCG Fertility policy Contents 1 Introduction 1 2 Individual Funding Requests 1 2.1 Eligibility criteria 1 2.2 Number of cycles funded 2 2.3 Treatment Pathway 3 Page
More informationIN VITRO MATURATION OF HUMAN OOCYTES
REVIEW ARTICLE IN VITRO MATURATION OF HUMAN OOCYTES Yu-Hung Lin 1,2, Jiann-Loung Hwang 1,3 * 1 Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, 2 School of Medicine, Fu Jen
More information